Purported Benefits, Side Effects & More


Purported Benefits, Side Effects & More

Common Names

  • Indian Echinacea
  • Chuan Xin Lian
  • Chiretta
  • Kalmegh

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Andrographis has been mostly studied for colds, flu, and upper respiratory infections.

Andrographis paniculata is used in traditional medicine to treat infectious diseases and fevers. In the lab, it exhibits antibacterial, antioxidant, anti-inflammatory, anticancer, and immunostimulating properties.

Preliminary studies suggest andrographis alone or in combination with other herbs may reduce duration and severity of upper respiratory infections associated with the common cold or flu. Other data suggest it may help some inflammatory conditions such as ulcerative colitis or rheumatoid arthritis, but more studies are needed.

Patients should use caution before using this herb as it may interact with many drugs.

What are the potential uses and benefits?
  • Colds and Flu

    Either alone or in combination with other herbs, andrographis may reduce duration and severity of cold and flu symptoms.
  • Immune function

    In a small trial of patients with HIV, andrographolides, the active ingredients in andrographis, increased the number of lymphocytes, suggesting improved immune function. However, the trial was interrupted midway due to an adverse event.
  • Cancer

    Lab studies suggest antioxidant and anticancer properties, but this has not yet been studied in humans.
  • Inflammation

    Small trials suggest benefit for inflammatory conditions such as rheumatoid arthritis and ulcerative colitis, but additional studies are needed to confirm these effects.
What are the side effects?
  • Headache
  • Fatigue, dizziness
  • Allergic reactions, hypersensitivity, skin rash
  • Lymph node pain or swelling
  • Nausea, diarrhea, vomiting
  • Altered taste

Case reports

  • Anaphylaxis and allergic reactions: Caused by several different A. paniculata preparations. Methanol extracts may increase this allergy risk.
  • Anaphylactic reaction: In an HIV patient on-study during week 4.
  • Enlarged lymph nodes: With very high doses.
  • Acute kidney injury: Following andrographolides given by IV. Symptoms included flank pain, decreased urine output, and nausea/vomiting.
What else do I need to know?

Do Not Take if:

  • You are taking aminophylline: Preclinical studies indicate that andrographis may increase the risk of side effects from this drug.
  • You are taking chemotherapy drugs: Andrographis has antioxidant effects and may interfere with the actions of chemotherapy drugs.
  • You are taking CYP450 substrate drugs: Although clinical relevance is yet to be determined, andrographis may make some of these drugs less effective or increase the risk of side effects.
  • You are taking blood pressure-lowering drugs: Andrographis may have additional hypotensive effects. A study in healthy humans showed transient reductions in blood pressure when taking the suggested dose for common cold and respiratory tract infections.
  • You are taking anticoagulants or antiplatelet drugs: Some lab studies suggest andrographis may interfere with these drugs. Patients taking these medications should use caution and consult their treating physician if considering the use of andrographis products.
  • You are taking UGT 2B7 substrate drugs: Lab studies suggest andrographolide derivatives may increase the side effects of drugs metabolized by this enzyme.

For Healthcare Professionals

Brand Name
Kan Jang, Kold Kare, KalmCold, Paractin
Scientific Name
Andrographis paniculata
Clinical Summary

Andrographis paniculata is a bitter tasting annual plant prevalent in much of Asia. It is often used in combination with other herbs in traditional medicine to treat infectious diseases and associated fevers. It is also used in folk medicine to treat snakebites. Andrographis is promoted in supplemental form for cancer prevention or treatment, and to counter chemotherapy toxicity in humans. Formulations containing standardized extracts of andrographis are also marketed for colds and flu.

Preclinical studies suggest antimicrobial (23), anti-inflammatory (26), antioxidant (27), anticancer (13) (15) (18) (49) (50) (51) properties.

Kan Jang, a standardized extract of A. paniculata and Eleutherococcus senticosus, has been studied in manufacturer-sponsored clinical trials for relief of respiratory symptoms from cold and flu (1) (2) (3) (4), and may help reduce severity and recovery time (56). An andrographis extract also appeared helpful for upper respiratory infections (5) and meta-analyses suggest possible benefit to reduce cough frequency and severity (45) (46).

Andrographis has also been evaluated for ulcerative colitis. In one trial, those receiving A. paniculata extract at higher doses were more likely to achieve a clinical response compared with placebo (47), and another study found it as effective as mesalamine (6).

Other preliminary data suggest andrographis extracts can reduce rheumatoid factors and arthritis symptoms (7). In patients with modest hypertriglyceridemia, reduced triglyceride levels with a high-dose andrographis extract were comparable to reductions with gemfibrozil (48). In a pilot study of patients with not-active progressive multiple sclerosis, andrographolide appeared safe and showed trends in reducing brain atrophy rates and disability progression (57).

Purported Uses and Benefits
  • Immunostimulation
  • Inflammation
  • Colds, flu
  • Cancer
Mechanism of Action

The active constituents of andrographis are diterpenoid lactones known as andrographolides (10) (11). They exhibit anti-inflammatory activity by inhibiting NO production and COX-2 expression (26). In mouse hepatocytes, andrographis induced mRNA expression of CYP1A1 and 1A2 in a concentration-dependent manner (31). In other studies, andrographis extract demonstrated a calcium channel inhibition effect that could cause smooth muscle relaxation, decreased blood pressure and heart rate (32), and relaxation of the uterus (33). It also showed antiplatelet effects by inhibiting thrombin (34) and platelet activating factor (35). When given orally to mice, andrographis extract neutralized snake venom (9).

In other preclinical studies, activity against multiple myeloma cells may occur via TLR4/NF-kappaB signaling pathway inhibition (52). In human colorectal cancer cells, reversal of 5-FU resistance was attributed to elevated BAX expression (50). Migration and invasion was inhibited through suppression of mRNA and MMP-7 protein levels (13), while MMP-2 activity was also identified (14). Inhibition of IL-6 expression and IL-6-mediated signals occurred in human prostate cancer cells (12). In non-small cell lung cancer cells andrographolides reduced invasiveness by suppressing the PI3K/Akt/AP-1 signaling pathway and inhibiting MMP-7 expression (15). Apoptosis in human hepatoma cells occurred via c-Jun N-terminal kinase induction (16) and caspase activation (17). Decreased adhesion of gastric cancer cells to endothelial tissue was attributed to inhibition of E-selection expression (18). Inhibition of tumor cell growth may also occur by stimulating cytotoxic T-lymphocyte production via IL-2 and IFN-gamma secretion (19). Andrographolides also enhanced doxorubicin-induced cell death in several human cancer cell lines, mainly through JAK-STAT suppression (20).

In HIV patients, andrographolides inhibited HIV-induced cell-cycle dysregulation and increased CD4+ lymphocyte levels (10).

Adverse Reactions

Headache, fatigue, vertigo, skin rash, hypersensitivity, lymphadenopathy, pain in the lymph nodes, nausea, vomiting, diarrhea, altered taste (10) (11) (44) (45) (46) (47) (53) (57) (58)

Case reports

  • Anaphylaxis and allergic reactions: Caused by several different A. paniculata preparations. Methanol extraction may increase risk of allergenicity (54).
  • Anaphylactic reaction: In an HIV patient on-study during week 4 (10) .
  • Lymphadenopathy: With very high doses (53).
  • Acute kidney injury: Following IV administration of andrographolides. Symptoms included flank pain, decreased urine output, and nausea or vomiting (41).
Herb-Drug Interactions
  • CYP450 substrates: Lab studies indicate andrographis extract inhibits 1A2, 2C9, 3A4 (37). Some andrographis compounds also induce CYP1A1 (39). Although clinical relevance is yet to be determined, these properties may affect the intracellular concentration of drugs metabolized by these enzymes.
  • Anticoagulants, antiplatelets: Although lab studies indicate possible inhibition of platelet aggregation (34) (35), one study in rats suggests that andrographis extract does not interact with warfarin when used concomitantly (38). Patients taking anticoagulant or antiplatelet medications should use caution and consult their treating physician if considering the use of andrographis products.
  • Chemotherapy drugs: Andrographolides have been shown to have antioxidant effects (21), which may interfere with the actions of some chemotherapy drugs.
  • Blood pressure-lowering drugs: Lab studies indicate that andrographis may have additive hypotensive effects (32). In healthy subjects, A. paniculata at the normal therapeutic dose for the common cold and respiratory tract infections modulated various clinical parameters, including transient reductions in blood pressure (55).
  • UDP-glucoronosyltransferase: Lab studies suggest andrographolide derivatives inhibit UGT2B7 and can increase the side effects of drugs metabolized by this enzyme (42).
  • Aminophylline: Andrographis inhibits CYP1A2, which is involved in metabolizing aminophylline, resulting in increased risk of side effects from this drug (43).
Herb Lab Interactions

May elevate liver enzymes (6).

Dosage (OneMSK Only)
  1. Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004;18(1):47-53.
  2. Kulichenko LL, Kireyeva LV, Malyshkina EN, Wikman G. A randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd. J Herb Pharmacother 2003;3(1):77-93.
  3. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7(5):341-350.
  4. Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9(7):589-597.
  5. Saxena RC, Singh R, Kumar P, et al. A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculata (KalmCold) in patients with uncomplicated upper respiratory tract infection. Phytomedicine. 2010;17(3- 4):178-85.
  6. Tang T, Targan SR, Li ZS, et al. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis - a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011;33(2):194-202.
  7. Burgos RA, Hancke JL, Bertoglio JC, et al. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. Clin Rheumatol. 2009;28(8):931-46.
  8. Mkrtchyan A, Panosyan V, Panossian A, et al. Aphase I clinical study of Andrographis paniculata fixed combination Kan Jang versus ginseng and valerian on the semen quality of healthy male subjects. Phytomedicine 2005;12(6-7):403-409.
  9. Samy RP, Thwin MM, Gopalakrishnakone P, Ignacimuthu S. Ethnobotanical survey of folk plants for the treatment of snakebites in Southern part of Tamilnadu, India. J Ethnopharmacol 2008;115(2):302-12
  10. Calabrese C, Berman SH, Babish JG, et al. A phase I trial of andrographolide in HIV positive patients and normal volunteers. Phytother Res 2000;14(5):333-338.
  11. Kligler B, Ulbricht C, Basch E, et al. Andrographis paniculata for the treatment of upper respiratory infection: a systematic review by the natural standard research collaboration. Explore (NY) 2006;2(1):25-29.
  12. Chun JY, Tummala R, Nadiminty N, et al. Andrographolide, an herbal medicine, inhibits interleukin-6 expression and suppresses prostate cancer growth. Genes Cancer. 2010; 1(8): 868-876.
  13. Shi MD, Lin HH, Chiang TA, et al. Andrographolide could inhibit human colorectal carcinoma Lovo cells migration and invasion via down- regulation of MMP-7 expression. Chem Biol Interact. 2009;180(3):344-52.
  14. Chao HP, Kuo CD, Chiu JH, et al. Andrographolide exhibits anti- invasive activity against colon cancer cells via inhibition of MMP2 activity. Planta Med. 2010;76(16):1827-33.
  15. Lee YC, Lin HH, Hsu CH, et al. Inhibitory effects of andrographolide on migration and invasion in human non-small cell lung cancer A549 cells via down-regulation of PI3K/Akt signaling pathway. Eur J Pharmacol. 2010;632(1- 3):23-32.
  16. Ji L, Liu T, Liu J, et al. Andrographolide inhibits human hepatoma-derived Hep3B cell growth through the activation of c-Jun N-terminal kinase. Planta Med 2007;73(13):1397-1401.
  17. Zhou J, Zhang S, Ong CN, Shen HM. Critical role of pro-apoptotic Bcl-2 family members in andrographolide-induced apoptosis in human cancer cells. Biochem Pharmacol 2006;72(2):132-144.
  18. Jiang CG, Li JB, Liu FR, et al. Andrographolide inhibits the adhesion of gastric cancer cells to endothelial cells by blocking E-selectin expression. Anticancer Res 2007;27(4B):2439-2447.
  19. Sheeja K, Kuttan G. Activation of cytotoxic T lymphocyte responses and attenuation of tumor growth in vivo by Andrographis paniculata extract and andrographolide. Immunopharmacol Immunotoxicol 2007;29(1):81-93.
  20. Zhou J, Ong CN, Hur GM, et al. Inhibition of the JAK-STAT3 pathway by andrographolide enhances chemosensitivity of cancer cells to doxorubicin. Biochem Pharmacol. 2010;79(9):1242-50.
  21. Shen YC, Chen CF, Chiou WF. Andrographolide prevents oxygen radical production by human neutrophils: possible mechanism(s) involved in its anti-inflammatory effect. Br J Pharmacol. 2002;135(2):399-406.
  22. Wiart C, Kumar K, Yusof MY, et al. Antiviral properties of ent-labdene diterpenes of Andrographis paniculata nees, inhibitors of herpes simplex virus type 1. Phytother Res 2005;19(12):1069-1070.
  23. Singha PK, Roy S, Dey S. Antimicrobial activity of Andrographis paniculata. Fitoterapia 2003;74(7-8):692-694.
  24. Dua VK, Ojha VP, Roy R, et al. Anti-malarial activity of some xanthones isolated from the roots of Andrographis paniculata. J Ethnopharmacol 2004;95(2-3):247-251.
  25. Burgos RA, Seguel K, Perez M, et al. Andrographolide inhibits IFN-gamma and IL-2 cytokine production and protects against cell apoptosis. Planta Med 2005;71(5):429-434.
  26. Liu J, Wang ZT, Ji LL, Ge BX. Inhibitory effects of neoandrographolide on nitric oxide and prostaglandin E2 production in LPS-stimulated murine macrophage. Mol Cell Biochem 2007;298(1-2):49-57.
  27. Verma N, Vinayak M. Antioxidant action of Andrographis paniculata on lymphoma. Mol Biol Rep. 2008;35(4):535-40
  28. Sheeja K, Guruvayoorappan C, Kuttan G. Antiangiogenic activity of Andrographis paniculata extract and andrographolide. Int Immunopharmacol 2007;7(2):211-221.
  29. Sheeja K, Kuttan G. Protective effect of Andrographis paniculata and andrographolide on cyclophosphamide-induced urothelial toxicity. Integr Cancer Ther 2006;5(3):244-251.
  30. Sheeja K, Kuttan G. Ameliorating effects of Andrographis paniculata extract against cyclophosphamide-induced toxicity in mice. Asian Pac J Cancer Prev 2006;7(4):609-614.
  31. Jaruchotikamol A, Jarukamjorn K, Sirisangtrakul W, et al. Strong synergistic induction of CYP1A1 expression by andrographolide plus typical CYP1A inducers in mouse hepatocytes. Toxicol Appl Pharmacol 2007;224(2):156-162.
  32. Yoopan N, Thisoda P, Rangkadilok N, et al. Cardiovascular effects of 14-deoxy-11,12-didehydroandrographolide and Andrographis paniculata extracts. Planta Med 2007;73(6):503-511.
  33. Burgos RA, Aguila MJ, Santiesteban ET, et al. Andrographis paniculata (Ness) induces relaxation of uterus by blocking voltage operated calcium channels and inhibits Ca(+2) influx.Phytother Res 2001;15(3):235-239.
  34. Thisoda P, Rangkadilok N, Pholphana N, et al. Inhibitory effect of Andrographis paniculata extract and its active diterpenoids on platelet aggregation. Eur J Pharmacol 2006;553(1-3):39-45.
  35. Burgos RA, Hidalgo MA, Monsalve J, et al. 14-deoxyandrographolide as a platelet activating factor antagonist in bovine neutrophils. Planta Med 2005;71(7):604-608.
  36. Panossian A, Hovhannisyan A, Mamikonyan G, et al. Pharmacokinetic and oral bioavailability of andrographolide from Andrographis paniculata fixed combination Kan Jang in rats and human. Phytomedicine 2000;7(5):351-364.
  37. Pekthong D, Martin H, Abadie C, et al. Differential inhibition of rat and human hepatic cytochrome P450 by Andrographis paniculata extract and andrographolide. J Ethnopharmacol 2008;115(3):432-40
  38. Hovhannisyan AS, Abrahamyan H, Gabrielyan ES, Panossian AG. The effect of Kan Jang extract on the pharmacokinetics and pharmacodynamics of warfarin in rats. Phytomedicine 2006;13(5):318-323.
  39. Chatuphonprasert W, Remsungnen T, Nemoto N, Jarukamjorn K. Different AhR binding sites of diterpenoid ligands from Andrographis paniculata caused differential CYP1A1 induction in primary culture in mouse hepatocytes. Toxicol In Vitro. 2011;25(8):1757-63.
  40. Chao WW, Lin BF. Isolation and identification of bioactive compounds in Andrographis paniculata (Chuanxinlian). Chin Med. 2010;5:17.
  41. Zhang WX, Zhang ZM, Zhang ZQ, Wang Y, Zhou W. Andrographolide induced acute kidney injury: analysis of 26 cases reported in Chinese Literature. Nephrology (Carlton). 2014;19(1):21-6.
  42. Ma HY, Sun DX, Cao YF, et al. Herb-drug interaction prediction based on the high specific inhibition of andrographolide derivatives towards UDP-glucuronosyltransferase (UGT) 2B7. Toxicol Appl Pharmacol. 2014;277(1):86-94.
  43. Li XP, Zhang CL, Gao P, Gao J, Liu D. Effects of andrographolide on the pharmacokinetics of aminophylline and doxofylline in rats. Drug Res (Stuttg). 2013;63(5):258-62.
  44. Suwankesawong W, Saokaew S, Permsuwan U, Chaiyakunapruk N. Characterization of hypersensitivity reactions reported among Andrographis paniculata users in Thailand using Health Product Vigilance Center (HPVC) database. BMC Complement Altern Med. 2014;14(1):515.
  45. Hu XY, Wu RH, Logue M, et al. Andrographis paniculata (Chuan Xin Lian) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One. 2017;12(8):e0181780.
  46. Wagner L, Cramer H, Klose P, et al. Herbal Medicine for Cough: a Systematic Review and Meta-Analysis. Forsch Komplementmed. 2015;22(6):359-368.
  47. Sandborn WJ, Targan SR, Byers VS, et al. Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. Am J Gastroenterol. Jan 2013;108(1):90-98.
  48. Phunikhom K, Khampitak K, Aromdee C, et al. Effect of Andrographis paniculata Extract on Triglyceride Levels of the Patients with Hypertriglyceridemia: A Randomized Controlled Trial. J Med Assoc Thai. Jul 2015;98 Suppl 6:S41-47.
  49. Gunn EJ, Williams JT, Huynh DT, et al. The natural products parthenolide and andrographolide exhibit anti-cancer stem cell activity in multiple myeloma. Leuk Lymphoma. Jun 2011;52(6):1085-1097.
  50. Wang W, Guo W, Li L, et al. Andrographolide reversed 5-FU resistance in human colorectal cancer by elevating BAX expression. Biochem Pharmacol. Dec 1 2016;121:8-17.
  51. Han Y, Bu LM, Ji X, et al. Modulation of multidrug resistance by andrographolid in a HCT-8/5-FU multidrug-resistant colorectal cancer cell line. Chin J Dig Dis. 2005;6(2):82-86.
  52. Gao H, Wang J. Andrographolide inhibits multiple myeloma cells by inhibiting the TLR4/NF-kappaB signaling pathway. Mol Med Rep. Feb 2016;13(2):1827-1832.
  53. Rahman H, Kim M, Leung G, et al. Drug-Herb Interactions in the Elderly Patient with IBD: a Growing Concern. Curr Treat Options Gastroenterol. Dec 2017;15(4):618-636.
  54. Gunawardana NC. Risk of anaphylaxis in complementary and alternative medicine. Curr Opin Allergy Clin Immunol. Oct 2017;17(5):332-337.
  55. Suriyo T, Pholphana N, Ungtrakul T, et al. Clinical Parameters following Multiple Oral Dose Administration of a Standardized Andrographis paniculata Capsule in Healthy Thai Subjects. Planta Med. Jun 2017;83(9):778-789.
  56. Narimanyan M, Jamalyan K, Balyan A, et al. Early intervention with Kan Jang® to treat upper-respiratory tract infections: A randomized, quadruple-blind study. J Tradit Complement Med. Nov 2021;11(6):552-562.
  57. Ciampi E, Uribe-San-Martin R, Cárcamo C, et al. Efficacy of andrographolide in not active progressive multiple sclerosis: a prospective exploratory double-blind, parallel-group, randomized, placebo-controlled trial. BMC Neurol. May 7 2020;20(1):173.
  58. Worakunphanich W, Thavorncharoensap M, Youngkong S, et al. Safety of Andrographis paniculata: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. Jun 2021;30(6):727-739.
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